Provider Demographics
NPI:1205370848
Name:MEDICA VITA LLC
Entity Type:Organization
Organization Name:MEDICA VITA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANDRIY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHETIN
Authorized Official - Suffix:
Authorized Official - Credentials:AP
Authorized Official - Phone:407-936-4238
Mailing Address - Street 1:5357 BAMBOO CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32811-6723
Mailing Address - Country:US
Mailing Address - Phone:407-936-4238
Mailing Address - Fax:
Practice Address - Street 1:710 W PRINCETON ST
Practice Address - Street 2:SUITE A
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-5214
Practice Address - Country:US
Practice Address - Phone:407-936-4238
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-16
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3700171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL171100000XOtherACUPUNCTURIST